The VA flubbed private care option after hiring a firm the Pentagon fired

Officials with the Department of Veterans Affairs chose a contractor to run its Choice Card program who was previously fired for allegedly defrauding the government after working on a similar contract with the Department of Defense.

(Photo from DoD)

The contractor, TriWest, now takes so long to schedule appointments with private healthcare providers that many veterans could shorten wait times by opting for traditional VA care, whose delays Choice was intended to allow veterans to escape.

Choice Card links vets with private doctors, but VA seemingly tried to sabotage the program, fearing it jeopardizes its budget.

TriWest contracts to administer parts of Tricare, the active military’s healthcare system, since 1996. TriWest paid $10 million in September, 2011, to settle charges that it defrauded the government by negotiating low prices with doctors but not passing the resulting savings on to taxpayers.

“Those who overbill Tricare threaten to undermine the health care provided to our men and women in uniform,” Tony West, assistant attorney general for the Civil Division of the Department of Justice, said of the legal settlement at the time.

But the standards seem to be lower for care owed to those who formerly wore the uniform of the U.S. military, because VA gave TriWest a contract in September, 2013, to run its Community Care program, a precursor to Choice Card that allowed veterans to use private doctors in some circumstances.

Inspector general reports said that program was run poorly, pointing the blame both at TriWest and the way VA set up their work. Meanwhile, Congress created the Choice Card program to enable any veteran delayed more than 30 days for VA care, or who didn’t live close to a VA facility, to seek private health care services.

VA managers and leaders of the American Federation of Government Employees (AFGE) union, which represents most of the department’s employees opposed it, fearing that fewer veterans in the government system would mean smaller budgets and fewer civil service jobs.

When VA leaders claimed budget shortfalls threatened closure of hospitals, they asked Congress to let them re-purpose $3.3 billion originally authorized for the Choice Card program.

When the bill became law anyway, VA gave the Choice Card contract to TriWest and HealthNet, another company that worked on Community Care.

A VA spokesperson said that “in order to enact [Choice] within 90 days, VA held an industry day to try to partner with industry to operate the program. Unfortunately, given the timeline set to roll out the program, VA’s only option was to modify a previously existing national community care contract, which was never intended to handle the scope” of the Choice Card model.

Official data obtained by The Daily Caller News Foundation shows that more vets are now waiting months for private care because contractors take so long to schedule appointments.

Consequently, VA bureaucrats and their union will likely get the result they sought: veterans going back into the government healthcare system despite its delays.

Private care doctors aren’t happy with the Choice Card initiative either, because the companies, which also manage payments, have been so slow to pay, causing many private care physicians to refuse veterans, leading to the same result.

A knowledgeable VA source told TheDCNF that after a patient does finally see a private doctor, TriWest takes up to 75 days to get the medical results of that appointment back into the VA system. That makes followup care impossible.

Darin Selnick, an Air Force veteran and former VA official under George W. Bush who now runs Concerned Veterans For America’s Fixing Veterans Health Care Taskforce, said that “TriWest and HealthNet may not have been the best choices,” but much of the failure is because VA “didn’t want it to work.”

Officials at VA “didn’t like the idea of patients going outside,” because “what does any organization want to do? It wants to get more money, more people, more power, it wants to grow,” Selnick added.

Scheduling delays happen because the system has a middleman, Selnick said. What other health care plan has “a system where you have to call a 1-800 number and they set up an appointment for you” with a provider that they select?,” he asked.

Half of all veterans are on Medicare anyway, so the VA should simply pay a small supplement to Medicare providers, instead of creating multiple administrative layers of VA bureaucrats and contractors in between veterans and healthcare workers, Selnick noted, which would purportedly save billions of tax dollars annually.

Those close to the issue believe “the chief problem with Choice is that we’ve had to rely on VA to implement it, and the department is just not very good at implementing things,” a spokesman for the House Committee on Veterans Affairs, which designed the Choice Card program, told TheDCNF

The committee never requested a third-party administrator to schedule appointments, the spokesman noted.

Companies involved in the Choice program defend their record. “Overall, TriWest is processing 90% of clean claims from providers within 30 days,” the company explained, adding that it got “exceptional” and “very good” performance ratings for its Tricare work, and saved the military money, but voluntarily entered a settlement on the assumption that more savings were possible.

Hiring people with prior records of failure is a pattern at VA. When hospital directors come under criticism for poor management, VA executives routinely remove them, then reinstate them at another hospital where the poor performance continues.

Only weeks after the Chicago VA fired Deloris Judd from the federal workforce for patient abuse and dishonesty, the Phoenix VA hired her to work on the Choice Card program.